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In a recent op-ed piece, former New Mexico Lt. Governor (under Bill Richardson) Diane Denish advocated the politically correct, but medically and fiscally ludicrous party line about Medicaid expansion. Her magical thinking and ill-founded policy recommendation cannot go unanswered.

It is true that "having 25% of our population uninsured is a huge cost." But before we ask where all that money is going, note that at least one quarter of all the uninsured are so by choice. The 2010 Report on Uninsured Americans from the GAO shows that 12-15 million qualify for government assistance but refuse to sign up. Will expanding Medicaid eligibility suddenly make them change their minds?

Next, there is the ever-popular "jobs" card -- the claim that expanding Medicaid will bring billions of free federal dollars into any other state listening to Washington's siren call. Those dollars could then be used, according to Denish, to "sustain our doctors and other health-care providers" and to create thousands of new jobs.

First, those free federal dollars are anything but free. They get added to the deficit, an ever-expanding bill we are passing on for our children to pay. Will the big government advocates ever accept that putting shackles on the future to pay for the present is a bad idea? For proof, they need only turn their gaze to the cradle of Western civilization: Greece.

Second, those dollars do not go to doctors and nurses for patient care. Indeed, provider reimbursements are reduced (again). All those billions of freshly minted dollar bills go to pay for new bureaucrats, regulators, overseers, managers, compliance officers, and directors. Money will indeed be spent on new jobs in healthcare, just not for the practice of medicine or nursing. There won't even be dollars to "sustain" the doctors and nurses we now have.

More and more doctors are refusing to see Medicare patients. With what the government pays providers, they simply cannot afford to do so. The same thing is happening in Medicaid, as dollars are taken from delivery of care and given to 'deliver' more and more...red tape.

(In the 19th century, documents drawn up by lawyers were tied together with red tape in order to show everyone that the documents were official.)

Health insurance premiums, which were already unaffordable for most people, are rising still higher. Denish (correctly) wrote, "As premiums go up, more businesses trim back on offering health insurance" to their employees. Before one can fix a problem, one must know the root cause.

Both Denish and the U.S. Congress avoid asking two key questions: 1) Why have health insurance premiums risen 20%-30% since the ACA was passed, and 2) Where is all that money going? (It sure as hell is not going to care providers!)

Consider the testimony before Congress and the warnings of large businesses such as Caterpillar, Deere, AT&T, Whole Foods, Medtronik, etc. When their CEOs did their fiscal due diligence, which Congress did not, they found that ACA expansion of the regulatory bureaucracy increases business costs by up to 25% per year. These bureaucratic (nonproductive) costs must be paid somehow. So insurance premiums rise to cover this cost-of-expanded-government, not the cost-of-patient-care.

We need to stop stealing dollars from patients to give them to healthcare bureaucrats.

I know many people that are able to have insurance through their employer, but choose not to spend the money.

In return they end up with more unpaid days off from work due to illness because they can't afford either the doctors visit, or the medication. Our medical plan allows you to visit a retail walk in clinic for $5 even if you have not met your deductable and see a PAC. We have no deductable on Rx drugs.

Then the same co-worker is crying that they are broke because they missed two weeks of work and had already burned up their paid sick time. Dumb asses.

It's all squeezing a balloon. We spend $8,362 per year per person in this country on healthcare. One way or another, that's what we spend. I don't understand why people want to give it to insurance companies all of their healthy years, and then go on Medicare when they get sick and/or old. We could spend less, but Paul Ryan (who is on government healthcare) wan't to keep giving money to private insurance companies.

It's all squeezing a balloon. We spend $8,362 per year per person in this country on healthcare. One way or another, that's what we spend. I don't understand why people want to give it to insurance companies all of their healthy years, and then go on Medicare when they get sick and/or old. We could spend less, but Paul Ryan (who is on government healthcare) wan't to keep giving money to private insurance companies.

Not real sure I understand what you're saying, but I'll give it a try.

I don't want to spend anything for health care; I have to.

All my life I have had health insurance. I used it in the event I got sick, so in that way it protected my net worth, which is hundreds of thousands. So I see healthcare insurance as a necessity. If I was a lackey with no real net worth I would not "need" health insurance because the hospitals would all treat me "for free".

"Going on Medicare" is not some sort of end game for losers. The government set it up for me because they know I can no longer get health insurance. Actually, I've been paying into it all my life; I just haven't been able to used it.

And how on earth can you say with a straight face "but Paul Ryan (who is on government healthcare) wan't to keep giving money to private insurance companies"? Private insurance companies provide protection from catastrophic loss due to sickness or accident. Is there something wrong with that?
Are you under the mistaken impression that Congressmen (like Ryan) do not pay for health care? Wrongo!http://www.dems.gov/matteroffact/do-...eir-healthcare

If I was a lackey with no real net worth I would not "need" health insurance because the hospitals would all treat me "for free".

That's a very expensive way to deliver healthcare to poor lackeys. The hospitals don't treat you for free, they treat you because they are required by law to render emergency care up to and including surgery and recovery, and then they bill you for it and come after you when you don't pay. This is, of course, one of the major reasons there is an entire industry out there which profits off of the working poor with ruined credit; Aaron Rents, Buy Here Pay Here, Drive Time Car Sales, Amscot, Walmart financial center, etc...

Lackeys, like you and I, would benefit from having a primary care physician and preventative care. Going to the ER and even Urgent Care with simple stuff is a huge part of the healthcare cost in the US.

If I am reading this correctly, an alternative to ER healthcare for lackeys would save hospitals and ultimately taxpayers $900 per visit. Personally, I think that if we could ever break the stranglehold on healthcare that the AMA has, we could save even more. Imagine how much time and money you could save if you could get up in the morning with an awful pain in your foot, and sign on to a Skype waiting room where you would see a doctor or PA, get a script emailed into CVS, and just go pick up your med?

"Going on Medicare" is not some sort of end game for losers. The government set it up for me because they know I can no longer get health insurance. Actually, I've been paying into it all my life; I just haven't been able to used it.

So doesn't it make more sense to pay into Medicare your entire working life and use it as your health insurance company during your healthy years as well? How does it make sense to carry private insurance all of your life and then shift to Medicare when you get old? You are paying three times: once for your healthy years health insurance, a slice to the private insurance company, and also into your Medicare future.

Part of the distortion of this issue is that those who are in the pocket of the health insurance companies (aka politicians) portray Single Payer as being entirely paid for by taxes, which ultimately it would be. But they act as if it's entirely a new expense, they aren't taking into account that workers and employers will not be let off the hook for premiums. Oh sure, the employers would love to simply dump health insurance and walk away from their contribution, but if we do this right then employers won't pay any less for worker healthcare than they do now, they simply won't have any say in the benefits nor will they be able to stifle worker mobility by having waiting periods and exclusions.

Imagine what it would do to the labor force, and small business, in the US if healthcare were universal Single Payer. Entrepreneurs could strike out on their own without putting their families and society at risk because they have no health insurance. Labor could go where the jobs are because they would have healthcare wherever they went. How many workers would put up with Walmart's bullshit if you could they the same pay and better benefits anywhere? Ooops! That's why big business hates the idea.

As I see it the major problem with providing health care at the government level is that is doesn't seem to cost the recipient anything. That why I put "for free" in quotes. We both know it's not free.

And it shouldn't be free. It should cost everyone something, and they should pay every time they use it - I mean pay out of their pocket, right then and there.
There are huge numbers of people who live their lives by using ER facilities knowing that someone else is going to pay for it; they don't know or care who. And those people are the problem. They will not pay; say they cannot pay unless forced to. I think at some level Obama knows this and that's why he is trying to force the issue of paying for health care payment on everyone.

At any rate I am opposed to government controlled health care because of the massive additional costs and waste associated with any government program. You name it, they'll screw it up.

But that is a far cry from your statement that someone wants to "give money to insurance companies". No one wants to give anything. I am sure you know perfectly well that insurance companies sell a product. Part of the problem is the way health care insurers operate in protected territories. They remind me of mob bosses dividing up the country. If it were up to me, all insurance companies would offer all products in all states.

I have no solution the the hoards of uninsured layabouts, which were created by the Democratic Party going back to "Great Society" programs. They will remain a blight on America until they all die, I suppose. But a decent economy would take care of the ones who have, by misfortune, landed in that state.

So doesn't it make more sense to pay into Medicare your entire working life and use it as your health insurance company during your healthy years as well? How does it make sense to carry private insurance all of your life and then shift to Medicare when you get old? You are paying three times: once for your healthy years health insurance, a slice to the private insurance company, and also into your Medicare future.

Part of the distortion of this issue is that those who are in the pocket of the health insurance companies (aka politicians) portray Single Payer as being entirely paid for by taxes, which ultimately it would be. But they act as if it's entirely a new expense, they aren't taking into account that workers and employers will not be let off the hook for premiums. Oh sure, the employers would love to simply dump health insurance and walk away from their contribution, but if we do this right then employers won't pay any less for worker healthcare than they do now, they simply won't have any say in the benefits nor will they be able to stifle worker mobility by having waiting periods and exclusions.

Imagine what it would do to the labor force, and small business, in the US if healthcare were universal Single Payer. Entrepreneurs could strike out on their own without putting their families and society at risk because they have no health insurance. Labor could go where the jobs are because they would have healthcare wherever they went. How many workers would put up with Walmart's bullshit if you could they the same pay and better benefits anywhere? Ooops! That's why big business hates the idea.

There are several fundamental flaws in your argument for "single payer" (or the ACA). Just to cite several:

1. While working most of us were on employer-paid (at least partially) private healthcare programs, which were part of our compensation package.....IOW, we EARNED those benefits, and paid for them personally, one way or the other. The government had nothing to do with this system, it was between the employer, employee, and the insurance carrier. If we didn't like the coverage offered, we had choices.....change employers, or go outside and purchase our own coverage.

2. Those of us who are retired and on Medicare, have many options now (but NOT after Obamacare is implemented), we can (and my wife and I do), pay extra for a "Medicare Advantage" plan that is "Cadillac" insurance, and pays for many things that regular Medicare doesn't cover......such as being able to go to the very best hospitals, like Mayo, and Sloan-Kettering if needed, all covered. The ACA strips away most of those options, relegating those who can afford better, higher quality care to the same lousy government approved care that is offered to those who can't afford better. Again, the liberal mantra of "equal outcomes", and those of us that can afford it have to go outside the system to receive higher quality care.

3. Retired people paid premiums for Medicare since 1965, without drawing a dime from those contributions until they reached 65 years of age......a prepaid policy.....not an "entitlement", it was required by law.......at the point of a gun. Not optional, now that the government has squandered those contributions, there is suddenly a "crisis".......the crisis is the fact that the contributions are gone, not that we need a new form of "entitlement" to replace the old method, which is going broke. Perhaps a better role for government would be rooting out every one of those polititions that squandered those funds and holding them accountable......

4. Actually, the overarching question remains that WHY, when throughout our working lives we paid for our own health coverage (through part of our employment, and through forced advance contributions to the Medicare system) are we now required to pay for someone elses coverage???? And to add insult to injury, we are also forced to accept the crappy coverage that the ACA requires in order for everyone to be "equal"???

5. Some people, mostly the young, chose to "self-insure", and not carry any health coverage at all......they assume the risk, and therefore are making a choice, why are they now to be forced to pay for a benefit that they will likely not use.......simple answer, a transfer of wealth from them to those who are "free-riders" on the current system.

I don't give a damn about the "uninsured", whether they can afford coverage or not......they weren't dying in the streets for the past century, and they won't be when Obamacare is repealed.......we tend to take care of our own in this country, we don't need 2100 pages of a law nobody understands to accomplish this, we have been doing it for a long, long time.

The bottom line is that regardless of how much liberals such as yourself would like it to be , healthcare IS NOT a "right" enumerated in the Constitution, and therefore far beyond the scope of the federal government's mandate to impose on the citizens.......free people are guaranteed choices in the US, not forced to submit to what the government determines is the appropriate method to care for ourselves.

That's a very expensive way to deliver healthcare to poor lackeys. The hospitals don't treat you for free, they treat you because they are required by law to render emergency care up to and including surgery and recovery, and then they bill you for it and come after you when you don't pay.

I just had a friend between jobs start at a community clinic for a diabetic related skin infection. He eneded up in the hospital with a 50k hospital bill. The hospital helped him apply for a grant through the state and the bill was waived. End of story.

In Nevada we have several hospitals that won't even accept Medicaid. So what is going to happen if the program is expanded?

There are several fundamental flaws in your argument for "single payer" (or the ACA). Just to cite several:

1. While working most of us were on employer-paid (at least partially) private healthcare programs, which were part of our compensation package.....IOW, we EARNED those benefits, and paid for them personally, one way or the other. The government had nothing to do with this system, it was between the employer, employee, and the insurance carrier. If we didn't like the coverage offered, we had choices.....change employers, or go outside and purchase our own coverage.

2. Those of us who are retired and on Medicare, have many options now (but NOT after Obamacare is implemented), we can (and my wife and I do), pay extra for a "Medicare Advantage" plan that is "Cadillac" insurance, and pays for many things that regular Medicare doesn't cover......such as being able to go to the very best hospitals, like Mayo, and Sloan-Kettering if needed, all covered. The ACA strips away most of those options, relegating those who can afford better, higher quality care to the same lousy government approved care that is offered to those who can't afford better. Again, the liberal mantra of "equal outcomes", and those of us that can afford it have to go outside the system to receive higher quality care.

3. Retired people paid premiums for Medicare since 1965, without drawing a dime from those contributions until they reached 65 years of age......a prepaid policy.....not an "entitlement", it was required by law.......at the point of a gun. Not optional, now that the government has squandered those contributions, there is suddenly a "crisis".......the crisis is the fact that the contributions are gone, not that we need a new form of "entitlement" to replace the old method, which is going broke. Perhaps a better role for government would be rooting out every one of those polititions that squandered those funds and holding them accountable......

4. Actually, the overarching question remains that WHY, when throughout our working lives we paid for our own health coverage (through part of our employment, and through forced advance contributions to the Medicare system) are we now required to pay for someone elses coverage???? And to add insult to injury, we are also forced to accept the crappy coverage that the ACA requires in order for everyone to be "equal"???

5. Some people, mostly the young, chose to "self-insure", and not carry any health coverage at all......they assume the risk, and therefore are making a choice, why are they now to be forced to pay for a benefit that they will likely not use.......simple answer, a transfer of wealth from them to those who are "free-riders" on the current system.

I don't give a damn about the "uninsured", whether they can afford coverage or not......they weren't dying in the streets for the past century, and they won't be when Obamacare is repealed.......we tend to take care of our own in this country, we don't need 2100 pages of a law nobody understands to accomplish this, we have been doing it for a long, long time.

The bottom line is that regardless of how much liberals such as yourself would like it to be , healthcare IS NOT a "right" enumerated in the Constitution, and therefore far beyond the scope of the federal government's mandate to impose on the citizens.......free people are guaranteed choices in the US, not forced to submit to what the government determines is the appropriate method to care for ourselves.